To critically appraise recent literature regarding breastfeeding outcomes and associated risks in HIV-infected (HI) and HIV-exposed (HE) infants, using the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) statement guidelines.
Materials and Methods:
Five electronic databases were systematically searched to obtain English publications from the last 10 years (2010–2020), pertaining to breastfeeding outcomes and associated risks of HI and HE infants and children. Gray literature sources were also included. Data were extracted according to various data items and were synthesized using thematic synthesis.
Results:
Of the initial 7,151 sources identified, 42 articles were eligible for final inclusion. The final selection included 19 cohort studies and 2 expert committee reports, classified as gray literature. The remaining 21 studies comprised case–control, cross-sectional, and randomized controlled trial studies. The following themes were identified: breastfeeding outcomes in HI and HE infants, risks for suboptimal breastfeeding, HI and HE infant growth and developmental outcomes, and barriers and facilitators to feeding decisions. Most studies highlighted HE infants' growth and developmental outcomes and did not directly interrogate breastfeeding outcomes. The most prevalent risks for suboptimal breastfeeding were maternal factors affecting decision making for breastfeeding.
Conclusions:
This systematic review adds to the evidence of breastfeeding in HIV-affected mother-infant dyads. Findings reiterated that exclusive breastfeeding has a positive outcome on growth and development of all infants irrespective of HIV status. The review highlighted a dearth of research on breastfeeding outcomes of HI and HE infants. Large-scale prospective comparative studies should profile breastfeeding and developmental outcomes of infants with HIV infection or exposure and antiretroviral treatment exposure to enable early identification and intervention for this vulnerable population in low-income settings.
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References
1.
GirumT, WasieA, WorkuA. Trend of HIV/AIDS for the last 26years and predicting achievement of the 90-90-90 HIV prevention targets by 2020 in Ethiopia: A time series analysis. BMC Infect Dis, 2018; 18:1–10.
2.
BlancheS. Mini review: Prevention of mother–child transmission of HIV: 25years of continuous progress toward the eradication of pediatric AIDS. Virulence, 2020; 11:14–22.
3.
OmoniAO, NtoziniR, EvansC, et al.Child growth according to maternal and child HIV status in Zimbabwe. Pediatr Infect Dis J, 2017; 36:869–876.
4.
VermeulenS. The validation of a screening tool for the identification of feeding and swallowing difficulties in the paediatric population with HIV/AIDS. Master's thesis, University of Cape Town, Cape Town, 2015.
5.
le RouxSM, AbramsEJ, NguyenK, et al.Clinical outcomes of HIV-exposed, HIV-uninfected children in sub-Saharan Africa. Trop Med Int Health, 2016; 21:829–845.
6.
EvansC, HumphreyJH, NtoziniR, et al.HIV-exposed uninfected infants in Zimbabwe: Insights into health outcomes in the pre-antiretroviral therapy era. Front Immunol, 2016; 7:1–12.
7.
WedderburnCJ, EvansC, YeungS, et al.Growth and neurodevelopment of HIV-exposed uninfected children: A conceptual framework. Curr HIV/AIDS Rep, 2019; 16:501–513.
8.
Al-MujtabaM, Sam-AguduN, KhatriRJ. Barriers to the practice of exclusive breastfeeding among HIV-positive mothers in sub-Saharan Africa: A scoping review of counselling, socioeconomic and cultural factors. J AIDS HIV Res, 2016; 8:70–79.
9.
CoetzeeB, TomlinsonM, OsaweS, et al.Barriers to and facilitators of adherence to exclusive breastfeeding practices among HIV infected and non-infected women in Jos, Nigeria. Matern Child Health J, 2017; 21:953–960.
10.
NieuwoudtS, MandersonL. Frontline health workers and exclusive breastfeeding guidelines in an HIV endemic South African community: A qualitative exploration of policy translation. Int Breastfeed J, 2018; 13:1–10.
11.
TuthillEL, PellowskiJA, YoungSL, et al.Perinatal depression among HIV-infected women in KwaZulu-Natal South Africa: Prenatal depression predicts lower rates of exclusive breastfeeding. AIDS Behav, 2017; 21:1691–1698.
12.
BlokhuisC, KootstraNA, CaanMWA, et al.Neurodevelopmental delay in pediatric HIV/AIDS: Current perspectives. Neurobehav HIV Med, 2016; 7:1–13.
13.
DaliliH, MohamadzadehY, DavoudiF, et al.Growth and development status in the first two years of uninfected children born from HIV positive mothers. Acta Med Iran, 2018; 56:176–180.
14.
SpringerPE, SlogroveAL, LaughtonB, et al.Neurodevelopmental outcome of HIV-exposed but uninfected infants in the Mother and Infants Health Study, Cape Town, South Africa. Trop Med Int Health, 2018; 23:69–78.
15.
KavleJA, LaCroixE, DauH, et al.Addressing barriers to exclusive breast-feeding in low- and middle-income countries: A systematic review and programmatic implications. Public Health Nutr, 2017; 20:3120–3134.
16.
South African National Department of Health. Guideline for the prevention of mother to child transmission of communicable infections. Pretoria, 2019.
17.
United States Department of Health and Human Services Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV transmission in the United States. 2017. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/PerinatalGL.pdf (accessed March26, 2018).
18.
TuthillEL, TomoriC, Van NattaM, et al.“In the United States, we say, ‘No breastfeeding,’ but that is no longer realistic”: Provider perspectives towards infant feeding among women living with HIV in the United States. J Int AIDS Soc, 2019; 22:1–13.
19.
World Health Organization (WHO). Implementation guidance: Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services: The revised baby-friendly hospital initiative. Geneva: WHO, 2018.
20.
South African Speech-Language and Hearing Association (SASLHA). Guidelines for early communication intervention. Johannesburg: SASLHA, 2017.
21.
VisserE, KrügerE, KritzingerAM. Feeding difficulties in infants with unrepaired cleft lip and palate and HIV-exposure. Afr Health Sci, 2018; 18:1098–1108.
22.
KrügerE, KritzingerAM, PottasL. Breastfeeding skills of full-term newborns and associated factors in a low-and-middle-income setting. Afr Health Sci, 2019; 19:2670–2678.
23.
ShamseerL, MoherD, ClarkeM, et al.Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: Elaboration and explanation. BMJ, 2015; 350:1–25.
24.
AdamsRJ, SmartP, HuffAS. Shades of grey: Guidelines for working with the grey literature in systematic reviews for management and organizational studies. Int J Manage Rev, 2017; 19:432–454.
25.
WilsonJ, MandichA, MagalhãesL. Concept mapping: A dynamic, individualized, and qualitative method for eliciting meaning. Qual Health Res, 2016; 26:1151–1161.
American Speech-Language-Hearing Association (ASHA). Evidence-based practice in communication disorders: An introduction. Rockville: ASHA, 2004.
28.
HigginsJPT, AltmanDG, GøtzschePC, et al.The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 2011; 343:d5928.
29.
WellsG, SheaB, O'ConnellD, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Ottawa, Canada: Ottawa Hospital Research Institute, 2013.
30.
CastleberryA, NolenA. Thematic analysis of qualitative research data: Is it as easy as it sounds?. Curr Pharm Teach Learn, 2018; 10:807–815.
31.
GoughD. Qualitative and mixed methods in systematic reviews. Syst Rev, 2015; 4:1–3.
AlmeidaCP, GoulartBN. How to avoid bias in systematic reviews of observational studies. Rev CEFAC, 2017; 19:551–555.
34.
MordenE, TechnauKG, GiddyJ, et al.Growth of HIV-exposed uninfected infants in the first 6months of life in South Africa: The IeDEA-SA collaboration. PLoS One, 2016; 11:e0151762.
35.
HampandaK. Intimate partner violence against HIV-positive women is associated with sub-optimal infant feeding practices in Lusaka, Zambia. Matern Child Health J, 2016; 20:2599–2606.
36.
le RouxS, DonaldK, BrittainK, et al.Neurodevelopment of breastfed HIV-exposed uninfected and HIV-unexposed children in South Africa: A prospective cohort. AIDS, 2018; 32:1781–1791.
37.
TahaT, NourS, LiQ, et al.The effect of human immunodeficiency virus and breastfeeding on the nutritional status of African children. Pediatr Infect Dis J, 2010; 26:514–518.
38.
ChaudhuryS, WilliamsPL, MayondiGK, et al.Neurodevelopment of HIV-exposed and HIV-unexposed uninfected children at 24months. Pediatrics, 2017; 140:e20170988.
39.
RupérezM, GonzálezR, MaculuveS, et al.Maternal HIV infection is an important health determinant in non-HIV-infected infants. AIDS, 2017; 31:1545–1553.
40.
ZashRM, Ajose-PopoolaO, StordalK, et al.Risk factors for mortality among HIV-exposed and HIV-unexposed infants admitted to a neonatal intensive care unit in Botswana. J Pediatr Child Health, 2014; 50:189–195.
41.
PhakisiS, Mathibe-NekeJM. Experiences of HIV-infected mothers regarding exclusive breast-feeding in the first six months of the infant's life in Mangaung, South Africa. Afr J Reprod Health, 2019; 23:27–34.
42.
ThomasE, KuoC, CohenS, et al.Mental health predictors of breastfeeding initiation and continuation among HIV infected and uninfected women in a South African birth cohort study. Prev Med, 2017; 102:100–111.
43.
McGrathCJ, NduatiR, RichardsonBA, et al.The prevalence of stunting is high in HIV-1–exposed uninfected infants in Kenya. J Nutr, 2012; 142:757–763.
44.
PetraroP, DugganC, MsamangaG, et al.Predictors of breastfeeding cessation among HIV-infected women in Dar es Salaam, Tanzania. Matern Child Nutr, 2011; 7:273–283.
45.
MagadiMA. Cross-national analysis of the risk factors of child malnutrition among children made vulnerable by HIV/AIDS in sub-Saharan Africa: Evidence from the DHS. Trop Med Int Health, 2011; 16:570–580.
46.
Rosala-HallasA, BartlettJW, FilteauS. Growth of HIV-exposed uninfected, compared with HIV-unexposed, Zambian children: A longitudinal analysis from infancy to school age. BMC Pediatr, 2017; 17:1–9.
47.
SudfeldCR, LeiQ, ChinyangaY, et al.Linear growth faltering among HIV-exposed uninfected children. J Acquir Immune Defic Syndr, 2016; 73:182–189.
48.
CournilA, De VincenziI, GaillardP, et al.Relationship between mortality and feeding modality among children born to HIV-infected mothers in a research setting: The Kesho Bora study. AIDS, 2013; 27:1621–1630.
49.
NlendAE, EkaniBB. Preliminary assessment of breastfeeding practices in HIV 1-infected mothers (prior to weaning) under the Djoungolo programme on the prevention of mother-to-child transmission of HIV. J Trop Pediatr, 2010; 56:436–439.
50.
SugandhiN, RodriguesJ, KimMH, et al.HIV exposed infants: Rethinking care for a lifelong condition. AIDS, 2013; 28:S187–S195.
51.
ArcharyM, FairlieL, SlogroveA. Current perspective on paediatric HIV management from the Mexico International AIDS Society Conference. South Afr J HIV Med, 2019; 20:1–5.
52.
SoméEN, EngebretsenIM, NagotN, et al.Breastfeeding patterns, and its determinants among mothers living with Human Immuno-deficiency Virus-1 in four African countries participating in the ANRS 12174 trial. Int Breastfeed J, 2017; 12:1–12.
53.
ThakwalakwaC, PhiriA, RollinsN, et al.Growth and HIV-free survival of HIV-exposed infants in Malawi: A randomized trial of two complementary feeding interventions in the context of maternal antiretroviral therapy. J Acquir Immune Defic Syndr, 2014; 66:181–187.
54.
WynnA, Rotheram-BorusMJ, LeibowitzAA, et al.Mentor mothers program improved child health outcomes at a relatively low cost in South Africa. Health Aff (Millwood), 2017; 36:1947–1955.
55.
ZashR, SoudaS, LeidnerJ, et al.HIV-exposed children account for more than half of 24-month mortality in Botswana. BMC Pediatr, 2016; 16:1–9.
56.
Kesho Bora Study Group. Formula-feeding of HIV-exposed uninfected african children is associated with faster growth in length during the first 6 months of life in the Kesho Bora Study. J Nutr, 2017; 147:453–461.
57.
MorataTC, HicksonL, WongL. The IJA system for systematic reviews: “The whys and hows.”. Int J Audiol, 2017; 56:213–214.
58.
LalbahadurM. Oral-motor function for feeding of HIV-exposed and unexposed infants. Master's dissertation, University of Pretoria, Pretoria, 2018.
59.
SlatteryJ, MorganA, DouglasJ. Early sucking and swallowing problems as predictors of neurodevelopmental outcome in children with neonatal brain injury: A systematic review. Dev Med Child Neurol, 2012; 54:796–806.
60.
DelaneyAL, ArvedsonJC. Development of swallowing and feeding: Prenatal through first year of life. Dev Disabil Res Rev, 2008; 14:105–117.
61.
IjumbaP, DohertyT, JacksonD, et al.Social circumstances that drive early introduction of formula milk: An exploratory qualitative study in a peri-urban South African community. Matern Child Nutr, 2014; 10:102–111.
62.
SidzeLK, FayeA, TetangSN, et al.Different factors associated with loss to follow-up of infants born to HIV-infected or uninfected mothers: Observations from the ANRS 12140-PEDIACAM study in Cameroon. BMC Public Health, 2015; 15:1–10.
63.
GoyalNK, AttanasioLB, KozhimannilKB. Hospital care and early breastfeeding outcomes among late preterm, early-term, and term infants. Birth, 2014; 41:330–338.
64.
RochatTJ, HouleB, SteinA, et al.Exclusive breastfeeding and cognition, executive function, and behavioral disorders in primary school-aged children in rural South Africa: A cohort analysis. PLoS Med, 2016; 13:e1002044.
65.
UmeobieriAK, MbachuC, UzochukwuBS, et al.Perception and practice of breastfeeding among HIV positive mothers receiving care for prevention of mother to child transmission in South-East, Nigeria. Int Breastfeed J, 2018; 13:1–8.
66.
SlogroveAL, EsserMM, CottonMF, et al.A prospective cohort study of common childhood infections in South African HIV-exposed uninfected and HIV-unexposed infants. Pediatr Infect Dis J, 2017; 36:e38–e44.
67.
GlassTJA. Retinopathy of prematurity and multiple postnatal infections in preterm neonates: Delays in white matter development with poorer neurodevelopmental outcomes. Doctoral dissertation, University of Toronto, Toronto, 2018.
68.
JadcherlaSR, WangM, VijayapalAS, et al.Impact of prematurity and co-morbidities on feeding milestones in neonates: A retrospective study. J Perinatol, 2010; 30:201–208.
69.
le RouxKW, ChristodoulouJ, DavisEC, et al.Maternal and child health outcomes in rural South African mothers living with and without HIV. AIDS Care, 2020; 32:452–461.
70.
le RouxSM, DonaldKA, KroonM, et al.HIV viremia during pregnancy and neurodevelopment of HIV-exposed uninfected children in the context of universal antiretroviral therapy and breastfeeding: A prospective study. Pediatr Infect Dis J, 2019; 38:70–75.
71.
GogaAE, DohertyT, JacksonDJ, et al.Infant feeding practices at routine PMTCT sites, South Africa: Results of a prospective observational study amongst HIV exposed and unexposed infants-birth to 9months. Int Breastfeed J, 2012; 7:1–11.
72.
LaneCE, BobrowEA, NdatimanaD, et al.Determinants of growth in HIV-exposed and HIV-uninfected infants in the Kabeho Study. Matern Child Nutr, 2019; 15:e12776.
73.
le RouxMS, JaoJ, BrittainK, et al.Tenofovir exposure in utero and linear growth in HIV-exposed, uninfected infants. AIDS, 2017; 31:97–104.
74.
Onyango-MakumbiC, OworaAH, MwiruRS, et al.Extended prophylaxis with nevirapine does not affect growth in HIV-exposed infants. J Acquir Immune Defic Syndr, 2019; 82:377–385.
75.
StrehlauR, van AswegenT, BurkeM, et al.A description of early neurodevelopment in a cohort of HIV-exposed uninfected children. AIDS Care, 2020; 32:1421–1428.
76.
DohertyT, HorwoodC, HaskinsL, et al.Breastfeeding advice for reality: Women's perspectives on infant feeding support received in primary health care settings in South Africa. Matern Child Nutr, 2019; 16:e12877.
77.
WestNS, SchwartzSR, YendeN, et al.Infant feeding by South African mothers living with HIV: Implications for future training of health care workers and the need for consistent counseling. Int Breastfeed J, 2019; 14:1–7.
78.
HimmelgreenDA, Romero-DazaN, TurkonD, et al.Addressing the HIV/AIDS-food insecurity syndemic in sub-Saharan Africa. Afr J AIDS Res, 2009; 8:401–412.
TomasoniLR, GalliM, DeclichS, et al.Knowledge, attitudes, and practice (KAP) regarding newborn feeding modalities in HIV-infected and HIV-uninfected pregnant women in sub-Saharan Africa: A multicentre study. Int Health, 2011; 3:56–65.
81.
SemrauK, KuhnL, BrooksDR, et al. Exclusive breastfeeding, maternal HIV disease, and the risk of clinical breast pathology in HIV-infected, breastfeeding women. Am J Obstet Gynecol 2011;205:334.e1–334.e8.
82.
PatelD, BlandR, CoovadiaH, et al.Breastfeeding, HIV status and weights in South African children: A comparison of HIV-exposed and unexposed children. AIDS, 2010; 24:437–445.
83.
WubnehCA, EndalamawA, TebejeNB. Predictors of mortality among HIV exposed infants at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Ital J Pediatr, 2019; 45:1–10.
